Income poverty and cardiovascular disease

Abstract

Schofield et al. presented a cross-sectional study on the association between working condition and health status, with special emphasis on cardiovascular disease (CVD), adjusted for sex, age and education [1]. Their studywas based on the 2003 Survey of Disability, Ageing and Carers (SDAC). The severity of CVD was not evaluated in their study, but it might be reasonable to speculate that the severity of CVD would be highest in patients with no job and lowest in full-time workers. They concluded that CVD in patients with no job was associated with the highest risk of living in poverty. The authors also reported the association between CVD and poverty using a three-dimensional model (low income, poor health and insufficient education) for poverty [2]. In this paper, the percentage of poor healthwas higher among thosewith heart and circulatory diseases than for other health conditions. By the way, they defined CVD as covering a broad spectrum of disorders including heart disease, angina, myocardial infarction, hypertension, stroke, and other heart/circulatory diseases, in Reference 1. Among the 8793 recorded subjects, those with chronic health conditions other than CVD were not used for their analysis. The numbers of full-time workers, part-timeworkers and persons with no job among the subjects with CVD were 349, 166 and 110, respectively, and the numbers of full-time workers, part-time workers and persons with no job among the healthy subjects were 2265, 783 and 625, respectively. They conducted logistic regression analysis to predict income poverty using working status among healthy subjects (Table 2 and Fig. 1 in Reference 1) and patients with CVD (Table 4 in Reference 1), while setting CVD patients with no job as the control group. To understand the association between income poverty and CVD, the combination of working pattern/status (full-time, part-time, and no job) and presence of CVD should be included as an independent variable for logistic regression analysis, in addition to sex, age and education. If full-time workers (n=2265) with no ill health were set as a control group, the risk of income poverty for other groups could be better estimated. In their study, the odds ratios and 95% confidence Fig. 1. Effects of the 3 new anticoagulants on all-cause mortality compared with dose-adjusted warfarin.